NCCC Tokumoto

NATIONAL HIV/AIDS CLINICIANSNATIONAL HIV/AIDS CLINICIANS’’ CONSULTATION CENTER CONSULTATION CENTER

WARMLINE, PEPLINE AND PERINATAL HIV HOTLINEWARMLINE, PEPLINE AND PERINATAL HIV HOTLINE

JASON TOKUMOTO, MD

Assistant Clinical Professor of Medicine

UNIVERSITY OF CALIFORNIA SAN FRANCISCO

DISCLOSURE: DR TOKUMOTO HAS NO FINANCIAL INTERESTS OR RELATIONSHIPS WITH COMMERCIAL ENTITIES WHOSE DISCLOSURE: DR TOKUMOTO HAS NO FINANCIAL INTERESTS OR RELATIONSHIPS WITH COMMERCIAL ENTITIES WHOSE PRODUCTS OR SERVICES ARE RELEVANT TO THE CONTENT OF HIS PRESENTATION.PRODUCTS OR SERVICES ARE RELEVANT TO THE CONTENT OF HIS PRESENTATION.

Warmline, PEPline, Perinatal

Telephone Consultation Service

WARMLINE 800.933.3413 NATIONAL HIV TELEPHONE CONSULTATION SERVICE

CONSULTATION ON ALL ASPECTS OF HIV CARE AND TESTING

PEPLINE 888.448.4911 NATIONAL CLINICIANS’ POST-EXPOSURE PROPHYLAXIS HOTLINE

RECOMMENDATIONS ON MANAGING OCCUPATIONAL(AND NON)EXPOSURES TO HIV AND HEPATITIS B & C

PERINATAL HIV HOTLINE 888.448.8765 NATIONAL PERINATAL HIV CONSULTATION AND REFERRAL SERVICE

ADVICE ON TESTING AND CARE OF HIV-INFECTED PREGNANT WOMEN ANDTHEIR INFANT. REFERRALS TO HIV-EXPERIENCED CLINICANS AND REGIONAL RESOURCES

National HIV/AIDS Clinicians’ Consultation CenterUCSF – San Francisco General Hospital

www.nccc.ucsf.edu

HRSA AIDS Education and Training Centers (AETC) Program, HIV/AIDS Bureau & HRSA Community Based Programs

with additional funding from Centers for Disease Control and Prevention (CDC)

Physicians Internal MedicineInfectious DiseasesFamily MedicineOb-Gyn

Clinical Pharmacists

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Expert consultation, free of charge

National Clinicians’ Consultation Center (NCCC)Warmline, PEPline and Perinatal Hotline

Consultations Provided by the NCCC

Total – 170,000 calls

2011 volume

Warmline (1992) 3585

PEPline (1997) 9678 Perinatal HIV Hotline (2004) 385

Total 2011 14,356 (1200/mo)

HIV+ Patient Load of Warmline Callers

Warmline Caller's HIV+ Case Load

0

50

100

150

200

250

300

0 1-3 4-10 11-25 26-50 51-100

101+

Case Load Categories

Nu

mb

er o

f P

atie

nts

Profession of Warmline Callers

Profession of Warmline Callers

Percentage

MD/DO 66.2%

NP/PA 14.8%

RN/LVN 5.6%

Other Medical 4.3%

Pharmacist (PharmD/RPh) 5.3%

Other Nonmedical 1.2%

Dental 0.5%

Unknown 2.0%

Facility of Warmline Callers

Facility of Warmline Callers Percentage

Community Clinic/Migrant Health Center

34.5%

Private Practice/Ambulatory 18.9%

Hospital 15.7%

Nonmedical 4.1%

Outpatient - Other 13.4%

Other Medical/Dental 7.9%

Unknown 5.4%

Warmline Call Topics

Warmline Call Topics Percentage

Drug Treatment Strategies 62.9%

Clinical & Laboratory Abnormalities

10.8%

Management of HIV-related Conditions

12.5%

Referrals & References 2.9%

Primary Care & Epidemiology 2.8%

Testing & Counseling 5.1%

Transmission & Prevention 2.8%

Warmline

Provide timely, state-of-the-art, evidence-based, and accurate consultation. Latest DHHS/CDC guidelines. Group consulting. Specialty consultation. Options.

Improve consultation technique. “Meet caller at where he/she is.” Question behind the question.

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Warmline question-antiretrovirals

What antiretroviral regimen? (First regimen – resistant virus) Obtain antiretroviral history. Request fax of all resistance tests results. Adherence. What patient can and will take and do. Liver function and renal function. Other medications. Provide options.

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Warmline – testing question

20 week pregnant female with no risk factors for HIV undergoes HIV screening test with a 4th generation HIV ½ test(tests for both HIV ab and P24 antigens).

Test is positive, WB indeterminate, P24 indeterminate.

One week later, retested. Test is again positive with an indeterminate WB; P24 antigen positive with RNA PCR and DNA PCR undetectable.

At 35 weeks, remains positive for the 4th generation test with an indeterminate WB(same bands) and P24 indeterminate.

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PEPline 888.448.4911Managing Occupational and Non-Occupational Exposures to Bloodborne

Pathogens

Steps in Managing BBP Exposures

Assess risk:

nature of injury and type of fluid

source patient factors

Determine whether to offer PEP

Select PEP regimen

Obtain baseline laboratory tests

Counsel the HCW and/or treating clinician

Follow-up care

Caller

14%

14%

72%

0 1000 2000 3000 4000 5000 6000 7000

Treating Clinician

Caller is exposed

Other

Caller Profession

13%

45%

42%

0 500 1000 1500 2000 2500 3000 3500 4000

MD

RN/NP/PA/CNM/LVN

Other/Unknown

Exposure Setting

38%

20%

10%

5%

26%

0 500 1000 1500 2000 2500 3000 3500

Hospital

ED

OR/L&D/Procedure

Outpt/Other Medical

Dental/Lab/Ambulance/other

Profession of the Exposed

20%

64%

16%

0 200 400 600 800 1000 1200

MD

RN/NP/PA/CNM/LVN

Other/Unknown

Exposure Fluid

28%

16%

56%

0 1000 2000 3000 4000 5000

Blood

Saliva

Other/Unknown

Exposure Category

16%

20%

64%

0 1000 2000 3000 4000 5000 6000

Percutaneous

Mucous Membrane

Cutaneous

PEPline

No occupational transmission of HIV since 2001. Documented US occupational HIV transmission

remains at 56. Another 138 possible US occupational HIV

transmission.

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Perinatal

1. Prenatal HIV antiretroviral regimens.2. Intrapartum issues e.g. rupture membranes,

mode of delivery.3. Antiretrovirals(PEP) for the infant.4. Ruling out HIV in the infant born to an HIV

+ mother. Work very closely with the HIV ob-gyn

specialist.

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